Wendy Sue Swanson, MD, MBE, FAAP2015-03-03T18:43:06-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/author/index.php?author=wendy-sue-swanson-md-mbe-faapCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Wendy Sue Swanson, MD, MBE, FAAPGood old fashioned elbow grease.E-Cigarettes: One Dead In New York and 'Vape' Is the Word of the Yeartag:www.huffingtonpost.com,2014:/theblog//3.63485222014-12-29T12:01:35-05:002015-02-28T05:59:01-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/word of the year for 2014. And while smokers-turned-vapers tout e-cigarettes as a safer alternative to cigarettes despite lacking medical data to back that up, there's a demographic being exposed to the liquid nicotine products for no good reason: children. I'm not just talking about the teenagers you hear about experimenting with vaping, I'm talking about toddlers getting into the stuff that isn't in a safe package or a safe place. This liquid nicotine that fills e-cigs smells sweet, tastes sweet and comes in candy-like wrappers.

Teens are exposed in unique ways, too. In my experience, teens are a key target market for e-cig advertisers and are perfect prey for nicotine addiction. Teens can get confused when hearing about the possible health benefits (harm reduction) in adults wanting to quit an old habit and they confuse or confer that for safety. Some teens have reported to me they have heard it will improve their sports and school performance. They think e-cigs may help them.

Nope.

There is no data to show e-cigs are good for anything in teens -- in fact we know nicotine increases HR and BP which in the end could decrease sports skills. Just a teaspoon of liquid nicotine can be lethal to a young child and we know nicotine can have lasting adverse consequences on teen brain development. Becoming addicted to nicotine (the big worry in my mind when it comes to teen use) could have secondary health effects leading athletes to cigarettes which we know won't improve their talent on the field.

Rates of e-cig use in teens rose from 4.7 percent in 2011 to 10 percent in 2012. Now a recent Pediatrics study of 1900 young high-schoolers in Hawaii shows 29 percent have tried e-cigarettes. Only 15 percent of the same group reported trying a cigarette. These e-cigs are getting around.

But as I said above, it's not just use among teenagers that's cause for concern. Young children living with or near nicotine may be at highest risk from e-cigs due to their innate curiosity and lagging judgment. The first child death related to exposure of liquid nicotine was reported this month. A 1-year-old child in New York died from exposure to liquid nicotine after officials have been warning of the risks from sales lacking regulation. The risks are being felt everywhere as the rates of calls to poison control rose from one report in September of 2010 to 215 calls in February of 2014. In Washington State where I live, >80 percent of calls about pediatric exposure to liquid nicotine to the poison center in 2014 were for children between 1 and 3 years of age.

This New York death represents an enormous tragedy for this family but also for our ability to prioritize safety over sales. We can't forget that the flavored nicotine used in e-cigs appeals to many senses in a toddler exploring their environment. Dr Alexander Garrard, Clinical Managing Director of the Washington Poison Center said, "The products smell very sweet, akin to a Jolly Rancher, so they're enticing to a number of different senses in kids. The packaging is very colorful as well." All these things draw a child to experiment and possibly ingest an unwanted toxin.

Currently there is a bill sitting in congress, the Child Nicotine Poisoning Prevention Act of 2014. The bill would require the Consumer Product Safety Commission to enforce child safety packaging for liquid nicotine containers. This sounds like a great first step but right now the bill is being reported to only have a 20 percent chance of being enacted. Perhaps the recent death will change political inertia.

E-cigarettes represent an $11.7 billion industry (in 2013) and yet congress has yet to take action and ensure the safety of children within reach of liquid nicotine. Protecting children from this toxin, I would say, is a current failure of pediatric public health. This extends past individual responsibility of parents and caregivers to keep liquid nicotine up and out of reach and right into the lap of lawmakers to advocate for the safety of our children.

]]>Why Boring Is Best: Un-Decorating Your Baby's Cribtag:www.huffingtonpost.com,2014:/theblog//3.62576142014-12-04T16:39:26-05:002015-02-03T05:59:02-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/Pediatrics study out this week found that parents commonly report using incorrect bedding (thick blankets [37 percent], blankets under baby [29 percent] most commonly). Soft bedding use was more prevalent in minorities, teenage mothers and moms with lower education levels (although it should be noted young moms were underrepresented in the study while white, higher-educated and older mothers were overrepresented). Lowest use of soft bedding was in college-educated moms, the highest use was in teen moms. Although it must be stated that study authors asserted all groups had high levels of soft bedding use with "1/2 of college-educated mothers putting their infants to bed with some type of bedding."

Bottom line: basic, boring, and bare cribs are best for babies. Less is more here.

We know bedding isn't everything when it comes to risk of sudden infant death syndrome (SIDS). The triple-risk model reminds us that risk for unexplained sudden infant death is a mixture of three things, only one of which we can control after the baby is born. The first risks are intrinsic risks, namely genetics, premature birth, male gender and prenatal exposure to alcohol/cigarette smoke. The second is age and timing, SIDS is most common between one and four months of age. But the third risk, and the one thing we as parents can truly control, is where our baby sleeps.

Bare, basic, boring cribs are best for baby.

After the "back to sleep" campaign launched in the mid-1990s pediatricians, midwives, nurses and public health officials had great success changing habits while encouraging parents to put babies to sleep on their back. But it seems progress is slowing a bit as we learn more about loose bedding and pediatricians just aren't getting the word out about like we need. Over the last 10 years or so progress has slowed. And while the numbers of SIDS have gone down, the number of unintentional sleep-related suffocation deaths has increased. Frankly, it's hard to get the message across when there are still many products on the market (and even more images in media) that go against the data that a bare crib with a baby in the center sleeping on the back is the safest.

Don't listen to grandma who's handing down the bumper from your distant cousin:All bumpers, even mesh ones, add an unnecessary risk to your baby's sleeping arrangements. No need to put or tie anything in the crib but a tight sheet and your beautiful baby.

You don't need a fancy crib: Take a tip from Finland, where expectant families are given a "baby box" or a "maternity packages." Everything a newborn could need comes in a box that is designed to double as the baby's first bassinet! Pretty awesome way to simplify -- however, of note I will say on closer inspection of the contents of the box I did see that the box includes a "sleeping bag," which is not be considered a safe item for infants' sleep.

Of note: Today the Ohio Chapter of the American Academy of Pediatrics reached out to share their message of #saynotobumpers. They're encouraging lawmakers to follow in the state of Maryland's footsteps and enact a ban on the retail sale of crib bumpers everywhere. Why sell them if they're not safe? Learn more about the campaign here.

]]>Pot In Your Pantry? Marijuana Use In Toddlers And Teenstag:www.huffingtonpost.com,2014:/theblog//3.60048822014-10-20T18:25:52-04:002014-12-20T05:59:02-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/ The second recreational pot store opened in Washington State recently while store number three is set to open later this month. Pace will quicken with several more stores expected to open by year-end. This puts Washington parents and pediatricians in a unique situation (shared only with Colorado) as we're tasked to explain to teens the dangers of legalized drugs used by adults. The complexity extends even to those of us with young children. Growing concern (and evidence) finds accidental ingestion of pot among children, often in the form of edibles, is also accelerating. In social channels I've heard some argue that marijuana legalization is to be thought of like alcohol but the packaging and delivery of the drug really are far different.

Marijuana Use By Teens Is Still Illegal Yet Common
Nearly half of all teens have tried pot by the time they finish high school while almost 1/4 of all high school students report having used marijuana in the past month. It could have wider implications than we previously thought. Consider effects like mental decline in teens who smoke and the reality that some research shows recreational use of marijuana is linked to brain abnormalities and IQ changes later in life. This may be especially true when pot is used in teens and others whose brains are still developing. Dr. Herbert Kleber, who directs the Division on Substance Abuse at Columbia University said to NPR, "There is a growing body of evidence that shows that marijuana isn't good for the developing brain. The adolescent brain is still maturing, and teens who use marijuana are more likely to become dependent on it than adults"

Fancy-Packaged Pot
It's not just joints and bongs that parents need to watch out for. Thirty five different marijuana-infused food and beverages have been approved by Washington State Liquor Control Board (cookies, trail mix, peanut brittle, gummy bears, and chocolate bars for example). Often the packaging for these products looks as attractive as a fruit roll-up or delicious candy bar typically marketed to children. Where I live and practice pediatrics, there have been 68 pediatric marijuana exposures voluntarily reported to Washington State poison control already this year. Because reporting isn't mandatory this potentially reflects an underestimate of the number of children exposed to marijuana accidentally.

What Can Parents Do?

If marijuana is in your house, keep it up and out of reach, especially if young children live or visit your home. Packaging for marijuana may be very attractive for toddlers or children and with a lapse in supervision (that happens to all of us) they may ingest marijuana unintentionally.

Talk about it with teens. I spoke with Dr Yolanda Evans, an adolescent expert at Seattle Children's who writes Teenology who said, "Communication is key for parents. Teens whose parents perceive marijuana as low risk are more likely to use. Know what the edible marijuana products look like and talk to your teen if you find something in their possession. Communicate your family values and expectations regarding use. Many of the products look like candy and treats that could be sold in any convenience store, but when you read the packaging, it will say it contains cannabis."

Set rules (and consequences) about drug use and follow through.

NO WEED WHILE DRIVING: "The first message we need to get out there is 'Don't use marijuana,' " Dr. Leslie Walker, chief of the Adolescent Medicine at Seattle Children's Hospital said to NPR, "But if you do, don't get behind the wheel."

Explain how marijuana works differently on the mind depending on how it is consumed. Dr Yolanda Evans again, "With edibles, children and teens may consume higher quantities than the inhaled form. It takes much longer for the THC to go through the gut than to be inhaled, so a teen may not experience a 'high' which leads to eating more and more. For children, the products may look like candy. Very appealing to a toddler."

]]>Ouchless Flu in 2014-2015: Nasal Flu Spray Recommended For Young Childrentag:www.huffingtonpost.com,2014:/theblog//3.59081282014-10-01T13:04:19-04:002014-12-01T05:59:01-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/Live Attenuated Influenza Vaccine (LAIV), a nasal spray, is a great option for those age 2 to 49 years old. In fact, there's data to suggest the nasal flu vaccine is more effective in protecting children from influenza in young childhood. Recommendations this year include a push to have children between 2 and 8 years of age immunized with the nasal spray whenever possible. If the nasal isn't available, the shot should be given -- no reason to wait.

We need the vaccine every year for two main reasons:

Typically, different influenza virus circulate around the world from year to year.Over 100 international centers maintain year-round surveillance to determine and predict which strain will cause human infections. The information is used to forecast the recipe for the vaccine here at home. This year the strains (types) of influenza in the shot and nasal spray are the same as last year (2013-2014).

Protection Fades. When you get a flu vaccine, you stimulate the immune system to create protection against the strains of the virus in the vaccine. That immunity (the antibodies that are created) tends to fade and wane in your bloodstream after about 6-12 months. Therefore, even if you got the flu vaccine last year, you really want your family to have it again this year so it protects you through the winter influenza season, which can continue late into the springtime, but tends to peak in February or March.

Age 2 and up: Children without serious stuffed up noses and no contraindications (see below) to nasal flu vaccine can get it.

Age 2 to 8: Especially recommended to have nasal flu spray if available, because it's been found to be more protective.

Age 8 & Up: Children over age 8 years of age without contraindication can also get a nasal flu spray, but there is no official recommendation for the nasal spray over the shot.

Kids Who Can't: Children are recommended NOT to get the nasal flu spray when on aspirin, if they have a history of an egg allergy, a weakened immune system, are around family members or close contacts who are immunosuppressed or have serious wheezing or persistent asthma in last year if between age 2 to 4 years.

What Parents Need To Know About Flu Vaccines

Flu vaccine (shot or spray) won't give you the flu. The effectiveness varies on a number of things, including how old the child is getting it, if the viral strains included are the ones circulating and the number of shots you've had in the past and timing of immunization. The flu shot is the best way to prevent influenza infections!

Children with underlying lung problems need to get a flu shot. However, if they have wheezed in the last year, talk with your child's doctor or nurse to see if they can have a nasal flu spray.

Children under 9 may need a second dose, especially if an infant or if this is the first season ever getting the flu vaccine. Talk with your child's care team for more information.

Protection lasts several months to a year -- now's the time for flu protection.

Information about nasal flu spray from CDC, Healthy Children and my "Debunking 5 Myths about the Flu"]]>LuluLemon's False Claim Is a Slap in the Facetag:www.huffingtonpost.com,2014:/theblog//3.55973662014-07-18T12:17:18-04:002014-09-17T05:59:06-04:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/sunscreen use, UV radiation, aging and skin cancer risks may pale in comparison to the potential power of a single quote on the side of a shopping bag. I mean, how can I compete with a company that sold $1.6 billon of merchandise last year and likely distributes tens to hundreds of thousands of reusable bags around North America everyday? Shopping bags have the luxury to walk around for years and tuck into peoples lives in remarkably intimate ways. Even I use these bags (or used to) to carry my lunch on a daily basis. It wasn't until yesterday that I realized I'd been carrying my lunch around in a bag that goes, in part, against my entire mission.

When I read about recent dermatologist outrage for Lululemon bag quotes I literally turned my head to my kitchen counter (see photo above) and there sat my lunch bag on my counter, just staring at me. Under the tote's handle was the devious myth, "Sunscreen absorbed into the skin might be worse for you than sunshine. Get the right amount of sunshine."

Now, that's not true. In fact there is no "right" amount of sunshine and absorption concerns for sunscreen haven't proved more dangerous than sunshine. Also, absorption varies with age and body site. Here I review information about why to use physical sunscreens (and sun protective clothing) in infants when possible to reduce any risk from ingredient absorption because of their more immature barrier. That being said, I'd always recommend sunscreen over sun exposure for infants and children. The conversation about getting sunshine is centered around getting enough vitamin D. Although minutes (not hours!) in the sun provides vitamin D, we can safely get vitamin D entirely from the food we eat or a daily supplement (all children are recommended to have at least 400 IU vitamin D daily). We don't need to consume sun. In fact, all sun exposure comes with UV radiation that contributes to mole production, aging and skin cancers -- even the most deadly kind, malignant melanoma. Sun protection keeps skin looking beautiful (prevents aging) and prevents skin from discoloration and cellular/immune changes that can lead to cancer. Sun-protective clothing, seeking shade, and sunscreen are our best bets for beautiful, healthy skin.

This Lulu bag controversy matters to me for two reasons really. One, retailers have power and I would suggest this Lululemon quote provides an illusion that more sun is better; research clearly supports that is untrue. To me, it's frustrating this kind of messaging slips through (and/or if this is intentional) knowing how intoxicating it can be. I suspect people will misinterpret this; the quote sure is a great excuse to go fry yourself on the beach. Companies interested in sharing health messages should partner with physicians, nutritionists, nurses and educators versed in messaging for final editing/approval. Two, this matters because this is another example of the attention economy's challenge -- how hard it is to reach a mass of people with important information. The retailers are just lucky in that regard. They have instant reach...

A few weeks back I read a parenting blog entry on the New York Times by a mom who penned content about the need to educate and support new parents in getting grandparents the Tdap vaccine after the birth of grandbabies. The goal is, of course, to "cocoon" a newborn -- surround them with people who are immunized so that their likelihood of getting whooping cough approaches zero because it doesn't make it into the house. I've written about this many times in the past, specifically addressing the need for grandparents to get the Tdap shot. In fact, I've even provided scripting and a sample email for new parents to send to family and friends. I've made YouTube videos, sent dozens of tweets and updated Facebook numerous times with information about Tdap, pertussis, newborns and community immunity. I also included this information (and the sample email for parents to use) in my book published by the American Academy of Pediatrics. So when her article concluded with this call to action I felt insanely frustrated:

But for something as serious as public health, perhaps it's time for medical professionals, government officials, and, yes, even the media to do a better job of outreach and education instead of just letting families battle it out themselves.

I had the feeling, "what more can I do?" I work in the media, I work with the Department of Health and CDC whenever I can to contribute to the national conversation about vaccine safety and hesitancy, I see patients in clinic and I share this vaccine education and prevention health info in every talk I do, no matter what the subject. I've committed my career to doing this work and still, my reach clearly isn't what it needs to be. When the New York Times publishes this post without acknowledging all the hard work public health officials, spokespeople and even bloggers like me do to avoid abandonment for families "battling it out themselves," I can't help wondering (out loud) how do we compete? Myths are instructional and it's very clear it is a challenge for people to unlearn things.

Bottom line: The Lululemon bags are just a slap in the face. As a pediatrician, mom, melanoma survivor and author committed to balanced, fair conversations about raising healthy children while staying somewhat sane, I really question how could they do it and feel OK about it. I haven't yet seen a Lululemon public response or commitment to remove the message. Until then, I'm cutting up my Lululemon bag. You, too?]]>You Mamas Taking Iodine?tag:www.huffingtonpost.com,2014:/theblog//3.55230172014-06-23T16:59:25-04:002014-08-23T05:59:05-04:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/

If you're either expecting a little one or have a new baby at home, you may want to reconsider trading table salt for alternatives like sea salt. A new policy statement from The American Academy of Pediatrics finds that many women, including up to 1/3 of pregnant women, may have low levels of iodine, putting them at risk for iodine deficiency.

The reason for the deficiency is the changing food source. Over the last 20-30 years, our major source of salt has shifted away from table salt (supplemented with iodine) to salt from processed foods, sea salt or gourmet salts that have no supplemental iodine. This is especially important for breastfeeding and pregnant women, as iodine is essential for thyroid function that supports fetal and newborn brain development.

This policy statement was news to me. I had no idea that the salt used to make most processed foods lacked iodine, that the majority of prenatal vitamins didn't provide iodine and that the number of women who may have a deficiency was so large. I'm not alone; when I polled my Mama Doc Facebook community, most moms and many doctors also commented this was a newsflash. Here's more on the new American Academy of Pediatrics recommendations:

Iodine Deficiencies - Shifting Salt Sources

Why do we need iodine? We need iodine for thyroid hormone synthesis as thyroid is essential in brain development and metabolism. The policy reminds us that even mild iodine deficiency can affect fetal and early childhood neurocognitive development stating, "adequate thyroid hormone production is critical in pregnant women and neonates because thyroid hormone is required for brain development in children."

Table salt intake: Table salt is iodized but many gourmet salts and salty, packaged foods lack supplemental iodine. Consider ensuring that when cooking in your home (i.e. putting salt in the pasta water or salting the veggies) you use iodized table salt so your intake of iodine goes back up. REMEMBER: This doesn't mean you should eat MORE salt, just swap in the table salt for the fancy salts when you can.

Isn't this in my prenatal?Research has also found that only about 15-20% of prenatal vitamins have the iodine you need (290 micrograms). You can up your iodine in your diet by eating food high in iodine. If you don't do that, recommendations are to take 150µg of iodine daily on top of your regular diet while pregnant or breastfeeding.

Iodine deficiency and pollutants: The statement also discusses how some environmental pollutants can compete with iodine for transport into thyroid tissue. Therefore, if you're somewhat iodine deficient and exposed to these chemicals, your thyroid function may suffer even more. So, work to avoid nitrates (found in well water), perchlorate (found in about 4% of public drinking water), and thiocyanate (found most often in cigarette and second-hand smoke). Taking supplemental iodine will help ensure these pollutants are not more dangerous to you or your baby!

The Skinny On Iodine Supplementation: 3 Things To Know

Iodine deficiency can affect a fetus or baby's development. Deficiency can also increase if exposure to certain pollutants in the environment.

If you or a family member is pregnant or breastfeeding, ask your doctor about taking 150 micrograms of iodine daily.

Use iodized table salt for cooking when you can. If you're not interested in taking supplements while pregnant or breastfeeding, consider increasing dietary iodine with seaweed, some fish like cod, shellfish, baked potato with skin or veggies that are high in iodine.

]]>What's Your Strategy for Keeping Your Kids Alive in the Car?tag:www.huffingtonpost.com,2014:/theblog//3.52699092014-05-06T18:07:04-04:002014-07-06T05:59:03-04:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/
This thought-provoking question came from Dr. Beth Ebel, Director of the Harborview Injury Prevention & Research Center, a pediatrician and researcher who spends her days working to improve safety for children in the car. During our conversation she stated that the last decade housed great success: there has been a 41% reduction in child passengers deaths involving alcohol-impaired drivers and a 44% reduction in death in child passenger deaths overall. In addition, she reminds me that 97% of drivers and passengers wear their seat belts! Even though she's proud of these numbers, she does note the ongoing deaths and how the 3% of the population who is unrestrained accounts for a huge proportion of the near-fatal and fatal injuries in car accidents.

New research out in Pediatrics provides a chilling lens into the realities of how young children in the U.S. die in the car. Car accidents remain the number one killer of children over age 4, and about 1 in 5 child passenger deaths in the U.S. involves an alcohol-impaired driver that's most commonly the child's own driver. The report focuses on children under age 15 who died in the last decade as a result of a car accident. I'd suggest this is uncomfortable data and somewhat uninteresting to most people. It does seem like this is just going to happen to someone else's kid, right? My concern is some of us may be wrong and while looking around, we better look closely at those we know well who also drive our children.

When looking at the new numbers, two facts jumped off the page for me:

65% of children who died in car accidents involving alcohol in the last decade died in the car with the drunk driver. That means those sweet little kids got in the car with a driver they likely trusted and died as a result of the driver's poor choice.

61% of the children who died were unrestrained (out of car seat, booster or seat belt) at the time of the crash.

Two Reasons Drunk Drivers Kill Children:

People drive with children when they are drunk.

People forget to get children into their car seats or boosters when they are drunk.

The great news is that over the past decade, the nation has seen a 40% decrease in deaths of children secondary to drunk driving. That's a huge deal. Researchers suggest this is because of improved child restraint laws and primary enforcement for seat belt use. When drunk drivers crash or crash into a car with children, kids are clearly much more likely to survive if they're restrained. We should be thankful that the cops can pull people over for not donning a seat belt -- this may have saved many lives. Over the decade, child restraint notably improved: the National Highway Traffic Safety Administration found that >34% of children who died in accidents in 2001 were unrestrained, but by 2010, only 20% of children who died were outside the car or booster seat.

12% of all children who die in a car accident die in a car with the drunk driver

Building a strategy to protect your family may be the most important thing you do to continue to change these numbers.

Building a Strategy to Protect Kids From Drunk Drivers:

Mr. Zero: Like every list, I can't fail to mention that you need a zero tolerance policy around alcohol and driving in your home. If you're going out for dinner, a party, picnic, etc. with alcohol, make sure you get a back-up driver (cab, Uber, friend) or have one designated driver. It can be inconvenient and uncomfortable, but clearly essential.

Look Around: Nearly all of us have alcoholism in our family and groups of friends. If you're concerned about the drinking in an adult who drives children in your house or in your life, don't wait to speak up. Dr. Ebel said, "Many people don't feel they have a ton of choice when they are dependent on someone helping them transport their children." In minimum, ensure your child always has their booster for carpool and transport, and teach children (around age 4) to always have their buckles on no matter what. Give them the skill independently to protect themselves. Why wait?

Protect Young Drivers: Somewhere around 30-40% of the drunk drivers involved in fatal accidents are young, new and inexperienced drivers between ages 16 and 24. Although the above study looked at the deaths of younger children, this group cannot go unmentioned. Have a strategy for your teen and college-age drivers. Help establish "safe autonomy" for your teens by establishing hard and fast rules and by using the "no questions asked" rule (below).

No Questions Asked Rule: For teens in your home, always let them know if they need a ride home you will come and get them anywhere, at anytime, and no questions will be asked and NO LECTURES given. Dr. Ebel provided this script, "I may not be happy and I may be in my bathrobe, but I promise I won't ask a single question and I'll always bring you home safely."

Justin Bieber was arrested early Thursday morning in Florida for an alleged DUI. The smirk on his face is a bit misplaced. While it's no longer a surprise when we hear about a celebrity's challenge with drugs and alcohol, Bieber serves up a perfect moment for education. I mean, this kid (he's 19 years old) really could have killed himself last night. Thank goodness he's only in jail. You got Bieber Fever in your house? Now's the moment to step in. The number one thing parents must remember is that data and research consistently show that a parent's opinion and guidance on avoiding alcohol remains the most powerful influence over a teen's decision to drink alcohol underage.

Alcohol-related injuries kill over 5,000 teens every year. Bieber's decision-making presents a huge opportunity to protect our own children. I'm reposting this data because we just can't forget how powerful we are, as parents, when protecting our children as they grow. Our job today is simply to remember our super power -- that we have influence. Don't brush this story off as "Bieber's a mess and an outlier." Lamborghini or not, every teen is at risk for making this kind of choice.

Tips For Talking With Teens About Alcohol And Survival

Majority Of Teens Don't Drink: Remind teens that it's the minority, not the majority, of teens who drink alcohol. Tell them the truth: The number of teens who say they've consumed alcohol before driving within the last month has decreased by 54% since 1991. Further, 9 out of 10 teens are doing a good job when it comes to drinking and driving -- 90% say they haven't had a drink and drove a car in the last month.

Drinking To Get Drunk -- Teens don't typically drink moderately. In fact, 85% of teens who drink say they binge drink (consume more than five drinks in a matter of a few hours). You can explain the difference and the risk that comes with binge drinking, especially when teens mix alcohol with caffeine (i.e. using energy drinks). Explain to teens it's never OK if a friend passes out from alcohol; ensure they know to call 911 if this occurs as alcohol poisoning can kill.

Teen Driving & DUI- First off, provide your teen reassurance that you will always help them find a safe way home (pick them up or paying for a cab) if their driver has been drinking. Detail the risks with drinking and driving-teen drivers are at much greater risk of crashing after drinking alcohol than older adults. Explain that it's illegal and if a teen gets a DUI they will lose their license and will be at risk of losing a college acceptance, a sports scholarship or other opportunities. In 2010, one in five teen drivers involved in a fatal crash had some alcohol in their system (of those, 80% were over legal limit).

Talk The Truth And Don't Stop- Talk about how drinking affects the brain early before kids drink and throughout high school. Alcohol moves through blood and goes to every organ, including the brain. Alcohol seriously can damage long-term brain growth and change how a person learns, thinks and remembers. Although 40% of 8th graders say their parents have talked to them about drinking, only 29% of 12th graders say their parents talk to them about alcohol. Don't give up! Teens need to know how drinking will affect them and that a person who is drinking is not a good judge of how impaired they are. Trying to terrify your teen may backfire. Instead, be truthful but avoid overly harsh scare tactics. Think of yourself as a go-to for info.

Sign A Contract- Teens do respond to contracts. Set clear no-alcohol use rules, and agree on appropriate consequences for breaking these rules. Enforce consequences when the rules are broken. Here's a sample TEEN Driving Contract you can print out and use (voila!!!)

I want you to put it in his helmet... I don't care if you don't get up. Let's go!

Or is it:

I want you to put it in his helmet... I don't care if he don't get up. Let's go!

Either is grim. The new show, Esquire's Friday Night Tykes, is getting quite a bit of attention. I suppose this was exactly the network's intent but there are very few cells in my body that can stay quiet about this. Reality TV has submerged to profound depths.

Seahawks in Seattle!

We're pulsing blue and green around here. There are 12s affixed to most every man-made structure in this town and our sense of Seattle-cohesion is undeniably improved. It's exciting to dream of a Super Bowl win for our Seahawks. We're ready for the 49ers this weekend (we even have our own Macklemore and Ryan Lewis playing at halftime) and most everyone in the Puget Sound is aware that football is providing a reason for giddiness. Like or hate the NFL, it's my experience that we're excited about our team...

First thing first: I know this is a pipe dream but I really wish a Seahawks player or coach would take the lead and discuss the disgust we should all have with Esquire and the crew involved in Friday Night Tykes promoting the abusive coaching. It's an understatement to say that I'm outraged some think it is not only permissible for children to participate in this program but that we are willing to elevate the scenario and call it entertainment. Perhaps the NFL won't permit this kind of public advocacy. Any ideas?

Concussions and Bullying: A Few Assumptions

FootballIt is impossible that executives, producers, coaches, parents, and perhaps even the children involved in this show are unaware of new research about early concussions (during childhood), the damaging effects of repeated concussions, and long-term risks for young athletes. You've heard of chronic traumatic encephalopathy -- deterioration and damage to the brain that causes increasing mental and physical disabilities over time after repeated trauma and I'm also assuming most of us, the Friday Night Tykes production team included, have heard about the NFL's $765 million settlement for brain injury/concussion claims (now currently being denied by a federal judge as not enough money). I'm assuming Friday Night Tykes also launched the show just as the final gasp of the 2013-2014 NFL season captures profound public attention.

And while I hold those assumptions confidently, I suspect the show producers and coaches haven't heard about the pediatrician-authored perspective published on Monday, Bullying Behavior By Athletic Coaches. I would suspect many would be surprised to learn that three-quarters of student athletes report emotional harm or bullying during their young sports' careers. A third of them identify the bully as their coach. The coach-athlete relationship obviously carries with it an imbalance of power so is primed for bullying-a systematic abuse of power.

75 Percent Child Athletes Report Bullying

More Common Than You Think: A 2011 UK study interviewed 6,000 young adults and asked them to reflect on their organized athletic sports. About three-fourths of them reported emotional harm and one-third of those pointed to the coach as the bully or instigator. Other reports have found over 40 percent of student athletes report coach bullying.

Bullying Is Bad For Us:Bullying has been shown to increase risk for anxiety, depression, sleep challenges, school performance, and hinder self-esteem.

Culture Of Coaching: Some coaches bully. In a thoughtful piece published this week, researcher Dr. Swigonski et al highlighted 4 ways in which coaches keep the bullying culture alive by using "defensive techniques to rationalize and minimize others' negative perceptions of the behavior." I suspect you'll recognize these in coaches you know.

Moral justification: A coach will try to convince others the behavior is normal and time-tested. You'll hear a coach say, "this is how I learned to tough it out" or "all coaches lose their temper sometimes." By stating this they try to normalize it amidst a school or group of kids and parents and thus shift expectations.

Backhand apology: This is where a coach uses the excuse that it's a player's inferior performance that caused the bullying in the first place. Authors of the study use this example, "I'm really sorry; I got a little carried way, but we really need to work on fundamentals if we are going to win."

Advantageous comparisons: This is where unacceptable behavior is used as a comparison. Authors highlight examples of a coach saying, "I don't ever lay a hand on them" as if to imply that it's only physical bullying that is problematic after emotional bullying or humiliation of an athlete has occurred.

Escalation: The coach raises the stakes on an athlete who may not like the bullying. They'll suggest a child quit if they "can't take it or don't like the way I do things." Authors clarify that it's not that bullying gets escalated, just the cost of pushing back (the threat of needing to leave the team).

You have to wonder what we're working to create here. Knowing that bullying has detrimental effects on self-esteem, school performance, anxiety, depression, and sleep it's my opinion we must find the right sports and the right coaches for our kids. When you see these behaviors can you intervene, inform school authorities, or even Child Protective Services if you're not getting anywhere?

What do we really want out of sports for our children?

I'm disgusted by the focus on Friday Night Tykes (most especially by their trailer) and the deranged way we avoid accepting responsibility for the health of our young, hopeful, innocent athletes under age 18. I won't tune into Esquire but I will be watching the Seahawks. A couple of boys around here have caught blue/green fever.]]>2013-2014 Flu Is Heretag:www.huffingtonpost.com,2014:/theblog//3.45716812014-01-10T11:11:22-05:002014-03-12T05:59:01-04:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/

Influenza currently has widespread activity here in Washington and fortunately, the news media has really picked up the story over the last couple of days. I say fortunately, because the more we know more about flu in our community, the better we can work to protect our families. There's no question that the clinic was full of coughs and colds yesterday!

At of the end of last week, the CDC reported that 25 states in the US have widespread influenza (see above map). In addition, public health officials confirm that H1N1 Influenza A is causing more serious, sometimes deadly disease in young adults. This post is simply a reminder that flu is here in our communities, work and schools. The best way to reduce the risk of serious influenza infection is still to get a flu shot - particularly if you're a middle-aged adult (!!), as young adults are bearing a particular burden of serious disease this season. In fact,there have already been a number of deaths in WA state. Many of the individuals who died were unvaccinated.

This is still true: pregnant women, young children, those over 65 years and anyone with underlying medical conditions are at higher risk for serious infection from influenza.

The great news: the 2013-2014 flu shot is a good match for the influenza that is circulating. As I explained back in November, the flu shot either has three or four strains of Influenza, depending on what shot or nasal spray you are offered. Every form of flu shot/nasal spray this year contains the H1N1 Influenza A strain that you're likely hearing about on the news.

What To Do If You Think You Have The Flu

Symptoms of flu include high fever, cough, cold symptoms and body aches. Stay home if ill to prevent spread and work to keep hydrated. Use fever-reducing medications if you or your child feel better with them on-board.

If you are concerned your infant is ill or infected with influenza, see your doctor. Infants are at higher risk for serious infections from flu.

If you or your children have underlying medical conditions, things like asthma, diabetes, heart disease, chronic medical problems, neurologic challenges or immune troubles, call your physician if you suspect you or your child have flu. For high risk children and adults, we sometimes use anti-flu medication during the first one to two days of illness to prevent serious infections from developing.

It's not too late for a flu shot. Call your clinic or visit the pharmacy to get one if you haven't yet this year. Don't wait-you'll be protected two weeks after getting the spray or shot. High levels of flu are expected to stick around for the next six to eight weeks here in Washington.

]]>Left to Chance With the iPottytag:www.huffingtonpost.com,2013:/theblog//3.44277492013-12-11T18:29:27-05:002014-02-10T05:59:02-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/Someone didn't believe me this AM when I said my children (5 &amp; 7) have never turned on the TV themselves. It's true

-- WendySueSwanson MD (@SeattleMamaDoc) December 5, 2013
I got in a heated discussion with a researcher last week. We were chatting about strategies to improve challenges with overweight individuals and obesity. He mentioned it was media controls (automatic locks on devices) that would change children's habits regrading screen time in the home -- he just didn't want to leave it up to parents anymore. As I understood his perspective, left to chance, it's unlikely parents will avoid screens when it comes at the cost of convenience. I mentioned to him that my young children watched very little television, that in fact, "They'd never turned the television on themselves." He looked at me sideways, he called my bluff. I told him again they literally had zero access to TV or other screens on their own.

I've carried this conversation with the researcher with me since. Not only because it rubbed me the wrong way, but because his presumptions are based in new realities. It was easier, even just seven years ago, to rear our children screen-free. I mean, the iPhone didn't exist when my 7-year-old was born. It's far more difficult to moderate screen use now that the majority of parents have smartphones in their pockets, laptops in the kitchen and tablets near the couch. Three-quarters of young children now live in homes with mobile devices (like my children). Those of us who avoid or limit screens have created huge work-arounds in our world.

Earlier this year, Common Sense Media published their Zero To Eight report detailing young children's media use. The report is worth a glance as the stats are fairly mind-blowing. A snaphot shows us:

3/4 of young children live in homes with mobile devices, some 38% of infants and toddlers have now used a mobile device.

1/3 of children have a television in their bedroom (16% of infants have one) and the likelihood that one ends up there increases with age. For children between 5 and 8 years of age, nearly 1/2 (45%) have a TV where they sleep. Most noteworthy for me: the main reason parents report that a child has a TV in the bedroom is to, "Free up other TVs so family members can watch their own shows."

Over 1/3 of families say the television is on "most or all of the time" in their home.

63% of children have played a game on a smartphone or mobile device with 17% of parents reporting their children (0-8 years) use a mobile device every single day.

The stats go on and on and it can all feel a little reckless. I'm keenly aware that stats don't really change behavior and I also really believe that if moderation is king guilt-free is queen. This post isn't designed to inspire guilt. The American Academy of Pediatrics reminds us that there is no developmental benefit to screen time prior to age 2 . Sometimes learning what TV does to your child's brain helps. I'm writing this because of 2 recent announcements:

Not a Screen-Free Place Around:

I can no longer think of a sacred place (without screens). In addition to the 2013 "innovation" of iPads being affixed to training potties, I recently learned about the iPad bouncy chair (the "Apptivity Seat) where a baby (a BABY!) can sit and play with their iPad. There's a rash of iPads affixed to all sorts of things this holiday season. Just last week, Applebee's restaurants announced they will be deploying 100,000 screens to their dinner tables. That's right, you and I now live in a country where your baby can plug into a device before they can talk and hold their head up and you're about to be saved from ever having to ask a server for onion rings, let alone talk with your family or friends.

Snarkiness aside, I think we need to reflect loudly about how we make choices as parents and consumers. Corporate America and big box retailers may not have your back in this regard. As these baby human beings' brains are rapidly making connections (young children make 700 synapses [connections between brain cells] per second during birth to 2 years), they are simply learning how to think. Do you really want the iPad doing the instructing?

It's fairly unsexy to say that babies need human interaction, song, discussion, tactile play, time and space for creative play with blocks, books, toys and games. Yet it's true that indeed it's what is better for them. Why is it so hard for us to believe and value that we humans are far better for our children than these technologies?

Left to chance, it's unlikely that parents of babies and young infants will avoid relying on screens as they raise their children, particularly as screens become unimaginably ubiquitous. I'd really love to hear your experiences and opinions on these iPad seats, potties and screen conveniences. You think I'm off here? Doesn't it make you mad that someone is trying to get rich as our children get less of us?

Further Reading:

The iPad Bouncy Seat: An Embarrassment To Human KindTell Fischer-Price No iPad Bouncy Seat For Infants (Campaign for A Commercial Free Childhood)]]>Smokeouttag:www.huffingtonpost.com,2013:/theblog//3.43190882013-11-22T17:15:24-05:002014-01-25T16:01:55-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/
Yesterday was the Great American Smokeout. A national day for quitting for all ages. Of course quitting smoking, even for a day, is an awesome step forward for health. Clearly finger-wagging and guilt-tripping really don't help smokers quit. I remember as a child lying on the floor when around a family member who was smoking saying, "Smoke rises... I'll stay down here." Fairly ineffective, I'm certain. Anecdotally, the family member is still a smoker. Nicotine is really addictive.

Cigarette smoking remains the number one cause of preventable death and premature birth in this country. And the risk of cigarette-related health problems start with the very first cigarette. That being said, recently I was talking with a colleague about her exposure to second-hand smoke as a child. She was joking that it was either all the diet soda she was drinking or her exposures to her parents' smoking in the car that would kill her.

I got to tell her the great news. Health benefits for smokers who quit start almost immediately. Don't underestimate the joy children exposed to second-hand smoke get when the air clears.

Benefits Of Quitting:
Health benefits to a smoker and their family start immediately. Not just the cosmetic benefits (smoking is kind of ugly) and olfactory ones (smoking stinks). Within 20 minutes of quitting heart rate and blood pressure drop. In the first day after quitting a smoker's carbon monoxide level in blood returns to normal and within weeks to months their lung function improves. For smokers it only takes a few months for coughing and shortness of breath to improve as well. There is great reward if smokers can get support to decrease their craving and addiction to nicotine to succeed in quitting. Other astounding benefits from American Cancer Society:

1 Year After Quitting: the risk of heart disease is ½ that of someone who keeps on smoking.

5 Years After Quitting: risks of cancer of mouth, throat, esophagus, and bladder are ½ of what they were while smoking. For smokers of any age, stroke risk can fall to that of a non-smoker after only 2-5 years!

10 Years Out: the risk of dying from lung cancer is ½ that of someone still smoking.

15 Years Out: the risk of heart disease for smokers who have quit is that of a non-smoker's! Seriously rewarding especially as heart disease remains the number one killer for both men and women in America.

If you or someone you know if thinking of quitting, I suggest framing the opportunity positively. Even posting one of the above factoids on your Facebook page today may help encourage a smoker to seek support. Secondhand smoke can also be a huge motivator:

Secondhand Smoke and Children

Smoking while pregnant increases the risk of SIDS for babies. Infants who live in homes with smokers also have higher rates of SIDS.

Children exposed to secondhand smoke are at a disadvantage. Studies show that older children whose parents smoke get sick more often when they are young. Children's lungs grow less than children who do not breathe secondhand smoke and they suffer more from bronchitis and pneumonia.

Wheezing and coughing are more common in children who breathe secondhand smoke.

Like other fumes, secondhand smoke can trigger an asthma attack in a child. Children with asthma who are around secondhand smoke have more frequent and more severe asthma attacks. A severe asthma attack can put a child's life in danger necessitating an ER visit or hospital stay.

Not just the lungs! Children whose parents smoke around them get more ear infections. They also have fluid in their ears more often and have more operations to put in ear tubes for drainage.

Babies lungs are more fragile and developing: do not allow anyone to smoke near your child, especially your infant.

In The Car: Do not smoke or allow others to smoke in your home or car. Opening a window does not protect your children from smoke.

At school: Use a smoke-free day care center.

Inside: Do not take your child to restaurants or other indoor public places that allow smoking. This is easier and easier as states adopt indoor smoking laws.

Out & About: Teach children to stay away from secondhand smoke.

Support for those interested in quitting. 7 things to do other than smoke.]]>PG-13 Movies: More Gunstag:www.huffingtonpost.com,2013:/theblog//3.42528632013-11-11T11:35:13-05:002014-01-23T18:56:26-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/
I was in fourth grade when Red Dawn debuted as the first PG-13 rated movie back in 1985. At the time Red Dawn was released, it was considered one of the most violent films by The National Coalition on Television Violence, with a rate of 134 acts of violence per hour, or 2.23 per minute. And although not every PG-13 movie has had significant violence (think Pretty in Pink) it turns out PG-13 and gun violence have become close bedfellows over the last 28 years.

New research out today in Pediatrics finds that gun violence is becoming a common pillar in the movies. Researchers sampled 945 films (all from the top 30 grossing films annually) since 1950, coding and evaluating five-minute violent sequences in those films. The results proved unsurprising, but nonetheless unsettling: overall gun-violent sequences more than doubled in the 60 years from 1950 to 2012. When looking specifically at PG-13 movies, researchers saw a tripling in gun violence since the rating was created in 1985. The trend for violence in these PG-13 movies has grown so rapidly it's created a new reality. Over the past 30 years, R-rated movies have shown no change in the amount of gun violence sequences while PG-13 have soared, making gun violence more prominent in PG-13 movies than in R-rated movies. Stunning, when you think of it -- gun imagery densely populating the movies targeting our teens. Yup, violence sells.

The Weapons Effect

Researchers embarked on this study in part because of concerns about "the weapons effect." They note that the national dialogue about guns and safety has been lacking mention of the weapons effect, that is, the fact that just seeing a weapon can increase aggression or aggressive behavior. It was more than 50 years ago that researchers first described the weapons effect, with 50 subsequent studies replicating the effect. Further study has found that even just hearing about guns can increase our aggression. The weapons effect is consistent in both angry and non-angry people.

Exposure to violent media can increase aggressive attitudes, behaviors and values, particularly in children. This finding has been scientifically reviewed and replicated numerous times; it is endorsed by 6 public health organizations (The American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, the American Academy of Family Physicians, the American Medical Association, the American Psychiatric Association, and the American Psychological Association).

Tips For Families

You're not imaging it, films approved for teens have gotten more violent. As Blockbuster fades into the ether there are three times the amount of gun-violent episodes in PG-13 films today compared to the 1980's. R-rated movies may have less gun violence than PG-13 ones.

Weapons Effect: Movies with gun violence bring the weapons effect into your home. Children and teens not only see weapons in these films they also can see characters and heroes acting out scripts for using guns. Think carefully before letting young children or teens view violent PG-13 movies. Research shows this kind of imagery increases aggressive attitudes, values, and behavior.

Reviews: Read reviews for movies, apps, and games prior to granting permission for watching/playing them. Review levels of violence and images of weapons in reviews. Check out Common Sense Media Movies Review for wisdom.

Friday Movie Night: Watch movies with your children and teens whenever you can -- know exactly what it is they're seeing and absorbing. Co-viewing movies with your children and teen is becoming more and more essential, especially after entering into the PG-13 movie aisle (online).

WATCH: PG 13 Violence
]]>Buying Breast Milk Onlinetag:www.huffingtonpost.com,2013:/theblog//3.41391892013-10-24T12:16:04-04:002014-01-23T18:58:21-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/New research out today confirms that buying breast milk on the Internet via milk-sharing sites may not be safe. Not surprising, I suppose. And although breast milk purchased from online sites may be free or as cheap as $1 an ounce, it may carry significant risk for babies. Clearly the benefits of breast milk are vast; pediatricians and health experts recommend exclusive breastfeeding until 6 months of age. However, simply put, breast milk obtained from individuals online may carry contamination from medications/drugs excreted in the breast milk, bacterial, or viral contamination. If a mother isn't able to provide enough breast milk for her newborn or infant, parents must know that milk from online sellers can be contaminated at the time of collection and/or during transport, dangerous especially for babies born prematurely. If buying human breast milk parents should look for a certified milk bank.

Back in 2010 the FDA spoke out against the practice of buying breast milk online, warning parents of potential risks due to bacteria or viral contamination, exposure to chemicals, medications, and drugs. The research out today confirmed these hesitations: nearly 3/4 of the breast milk obtained by researchers online had bacterial contamination and 20 percent of the samples tested positive for a virus called CMV.

It should be noted that breast milk bacteria (or virus) counts aren't deterministic for infection, meaning that just having bacteria in a breast milk sample doesn't mean a baby will get sick from it. How old a baby is, the amount of bacteria in the sample, and the immune status of an infant all also play a part. However, there are reports of premature babies and babies with immune dysfunction becoming seriously ill from donated unpasteurized breast milk so caution is necessary.

To be very clear the breast milk obtained and studied in the new research was NOT from a milk bank. Human Milk Banking of North America (HMBANA) breast milk banks screen donors for infections (like HIV) and pasteurize the breast milk to ensure improved safety protection. The trouble for many families unable to make enough breast milk with using these banks can be very costly secondary to the handling, screening, and pasteurization. Milk can be several dollars an ounce!

The Internet Purchased Breast Milk:

Researchers in Ohio obtained over 100 samples of donated breast milk through an unnamed, online breast milk site for testing. Just Google "buy breast milk" for some examples of online breast milk sharing sites. In the study researchers requested, paid for, and tested breast milk obtained online. They charted time in shipping, temperature upon arrival and tested milk for contamination with bacteria and viruses. In the study, 74 percent of the breast milk obtained online was found to have bacterial contamination on testing. Much of the bacteria found in the collected milk was gram-negative bacteria some gram-positive bacteria ("staph") that tend to live on our skin. Three samples of breast milk collected were contaminated with salmonella bacteria. About 1 in 5 samples tested positive for CMV DNA.

Bacterial contamination was more likely the longer it took for the breast milk to arrive. Although 1/2 of the samples arrived within two days, 12 percent required three to six days. Each additional transit day was associated with an increase in total bacteria count. Some sellers of the milk promoted their diet or exercise habits or lack of using medications. None of these claims was predictive of bacteria counts or presence of CMV (virus).

Researchers compared the online-obtained breast milk samples to samples of breast milk obtained (prior to pasteurization) from a HMBANA-member milk bank. The samples found online were significantly more contaminated that those collected for a milk bank. Researchers theorized that because milk donated to a bank are screened and come from women screened and counseled on proper technique for collection, they may send in less contaminated milk overall secondary to improved hygienic handling practices.

This research really provides just some of the first information about Internet-purchased human breast milk. The far majority of moms do breastfeed their babies at the start (77 percent) but not all moms can produce enough breast milk for their infants. If you're a mom having a challenge with milk supply or know a mom with a challenge, the first step can always be talking with a lactation consultant for support in enhancing milk production. If a family wants to purchase supplemental breast milk this new research and the current FDA recommendations suggest it's best to avoid unscreened online Internet donors. My recommendation is if you're going to get breast milk from someone other than mom, only purchase breast milk from a HMBANA-member milk bank.

American Academy Of Pediatrics Policy on Breastfeeding]]>Consistency May Be the 'Secret Sauce'tag:www.huffingtonpost.com,2013:/theblog//3.40989932013-10-21T00:10:05-04:002014-01-23T18:58:21-05:00Wendy Sue Swanson, MD, MBE, FAAPhttp://www.huffingtonpost.com/wendy-sue-swanson-md-mbe-faap/
A new study published in Pediatrics evaluated data from over 10,000 children in the UK. As a part of a larger study (UK Millennium Cohort Study), researchers collected bedtime data at age 3, 5, and 7 years for children. They found children with non-regular bedtimes had more behavioral difficulties. Further, as children progressed through childhood, there was incremental worsening in children's behavior scores as they were exposed to more and more inconsistent bedtimes.

Behavior And Children's Sleep:

Sleep schedules are clearly shaped by many influences -- a family's routine, their activities, their employment, their dinnertime and their socioeconomic situation can all impact what time children get to bed each night. In the Pediatrics study, researchers found that children without regular bedtimes and those with late bedtimes (after 9 p.m.) had more socially disadvantaged situations -- i.e., they were more likely to be from the poorest homes, have parents without advanced school degrees and have mothers with poor mental health. Children with late or inconsistent bedtimes were also more likely to skip breakfast, not have stories read to them and have a TV in their bedroom compared with their peers.

Lack of sleep influences behavior. It's certainly well-established that sleep deprivation makes it challenging for children to function, regulate their mood and their temper. Our children clearly play this scientific fact out for us when we stretch them!

Poor sleep and behavior: chicken or the egg? Research has not entirely teased out the relationship with fractured or challenged sleep -- is it that poor sleep leads to worse behavior, or children with behavior challenges also have a difficult time sleeping? Lots of variables at play here.

Bedtime inconsistency can disrupt circadian rhythm and can make children more sleep-deprived (less sleep in total is often observed in children who go to bed at different times each night).

Pediatrics Study on Bedtime Consistency & Behavior Challenges
Over 10,000 children were tracked from 9 months of age up to age 7 years. Children with diagnosed ADHD, autism or Asperger syndrome were excluded from the study.

Method: Researchers charted children's bedtime (as reported by their family) and behavior scores from a mother's report and teacher's report based on what time they went to bed. Researchers used the Strengths and Difficulties Questionnaire (SDQ) at age 7. Bedtimes were reported at 30 minute intervals (before 7:30 p.m., between 7:30 and 8 p.m. up until 9:00 p.m. or later) throughout childhood (age 3, 5 and 7 years). Parents could also report not having a regular bedtime.

Results: children without regular bedtimes had more behavior problems as indicated by both mother's and teacher's reports on the SDQ.

Dose dependent response: the data from the study found that the worse the consistency in bedtime routine, the worse the behavioral scores for children at age 7 years. For example, there was a doubling in the magnitude of effect for each increase in exposure to nonregular bedtimes. Basically, the more consistent you are with bedtimes, the less likely your child will have behavioral problems. And the good news: the better you make bedtime consistency as time goes on, the better the behavioral outcomes will potentially be.

Reversible: if routines improved around bedtime, behaviors improved too. For children who went from not having regular bedtimes to having more consistent bedtimes over the years, researchers saw improvements in behavioral scores as children aged. Researchers wrote, "For children who changed from not having regular bedtimes to having them there were improvements in behavioral scores, and for children who changed from having to not having regular bedtimes, there is some evidence for a worsening in behavior. The size of the effect was non-trivial."

Tips For Improving Your Sleep Routine:

Setting regular bedtime early in childhood is important. From the very beginning of infancy (at 1-2 months of age) we give our children the chance to learn to fall asleep on their own and start to expect a routine or pattern around bedtime. As they move through toddlerhood and young childhood, we want to set them up for success with the same bedtime each and every night. This is just another place where consistency is essential.

Without a reliable and regular bedtime routine, children may disrupt natural circadian rhythms. In addition, sleep deprivation is more likely in children whose bedtimes move all around. Pick a time that works for your family (7:30, 8:00, or 8:30 p.m.) for bedtime and do your best to stick to it every day of the week.

No TV in bedroom. Screen time and TV viewing before bed certainly disrupt your child's ability to fall asleep. Devices like smartphones and tablets will also make it harder for children to fall asleep. Although up to 30-40% of young children have TVs in their bedrooms in the U.S., we have to work to break the habit (from the very beginning) of letting children sleep with screens.

Most children under age 12 naturally get tired around 8 p.m.. That natural rise in melatonin, the hormone that allows our brains to chill-out and drift off to sleep, is typically bounding around 8 p.m. until children enter puberty. Use the melatonin spike to your advantage and set bedtime around 8 p.m. if you can. The use of natural cues like winding down activities (reading), bath, and blocking out light also help children establish a daily bedtime.